Perq dev breast 1st strtctc

CPT 19283 covers the placement of a localization device in the breast using stereotactic (3D x-ray) guidance for the first lesion. This is typically done before surgery to help the surgeon locate abnormal tissue that can't be felt during physical examination.

Showing rates for

National Average

Base Medicare rate

$247.13

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

PE RVU (NF)

5.44

MP RVU

0.2

Total RVU

7.64

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

Loading bundling edits…

Billing tips

Verify place of service code accuracy—POS 22 (outpatient hospital) vs. POS 11 (office) determines whether facility ($94.78) or non-facility ($247.13) rate applies, a difference of $152.35
Impact: $152.35 difference per procedure based on setting; incorrect POS coding is a leading cause of reimbursement errors
For multiple lesions in the same breast, bill 19283 for the first lesion and add-on code 19284 for each additional lesion; never bill 19283 multiple times for the same breast
Impact: Prevents bundling denials and ensures proper payment for additional lesions at approximately $100+ per add-on code
Always append RT or LT modifier to indicate laterality; this is a CMS requirement for all bilateral procedures and codes describing paired organs
Impact: Prevents claim rejection or 20-30 day payment delays for modifier requests
Document that stereotactic guidance was actually used with permanent imaging in the medical record; if ultrasound was used instead, code 19281 applies, not 19283
Impact: Using wrong guidance code can result in $50-80 payment difference and potential upcoding allegations
Ensure the radiology report separately documents both the guidance component and the device placement; combined documentation supports the integrated nature of 19283
Impact: Inadequate documentation is cited in 30-40% of audits for this code family, risking recoupment
Verify that surgical excision following localization is billed separately (19125, 19301, etc.) and not bundled; these are distinct services with separate reimbursement
Protects additional $400-1200 in surgical reimbursement depending on excision complexity

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 19283?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 19283 in 2025?

The 2025 Medicare national average reimbursement for CPT 19283 is $247.13 in non-facility settings and $94.78 in facility settings. The significant difference reflects that facility settings provide equipment and overhead, while non-facility settings must cover these costs within the reimbursement.

How many RVUs is CPT code 19283 worth?

CPT 19283 has a total RVU value of 7.64, broken down as: 2.0 work RVUs, 5.44 practice expense RVUs (non-facility), 0.73 practice expense RVUs (facility), and 0.20 malpractice RVUs. The work component reflects physician time and intensity.

Can CPT 19283 and 19284 be billed together?

Yes, 19283 and 19284 are designed to be billed together when multiple lesions in the same breast require localization. Code 19283 is used for the first lesion, and 19284 is the add-on code for each additional lesion in the same breast during the same session.

What is the difference between CPT 19281 and 19283?

The difference is the imaging guidance method used. CPT 19281 is for breast localization device placement using ultrasound guidance, while 19283 is specifically for stereotactic (mammographic) guidance. The guidance method must match what was actually performed and documented.

Does CPT 19283 require a modifier for laterality?

Yes, CPT 19283 requires either the RT (right) or LT (left) modifier to indicate which breast received the localization device. This is a CMS requirement for all procedures on paired organs, and missing laterality modifiers will result in claim denials or delays.

Is CPT 19283 bundled with the surgical excision code?

No, CPT 19283 is not bundled with breast surgical excision codes (such as 19125 or 19301). The localization is a distinct pre-operative service and should be billed separately from the surgical excision, though both may occur on the same date of service.

What specialties typically bill CPT code 19283?

CPT 19283 is most commonly billed by radiologists and breast imaging specialists who perform the stereotactic-guided localization procedure. Breast surgeons and surgical oncologists may also bill this code if they perform the localization themselves in their facility, though this is less common.